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Effectiveness of In-Clinic Rehabilitation Versus Home-Based Telerehabilitation for Adults With MS in the Deep South:
Tapan Mehta1, Hui-Ju Young2, Tracy Flemming-Tracy3
1Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL; National Center on Health, Physical Activity and Disability (NCHPAD), Birmingham, AL.
Objective:
To compare the effectiveness of a 12-week complementary and alternative medicine (CAM) program for people with multiple sclerosis (MS) delivered by a therapist in a clinic (DirectCAM) vs self-initiated at home (TeleCAM).
Design:
Pragmatic cluster-randomized controlled trial.
Setting:
Forty-three clinics across Alabama, Mississippi, and Tennessee.
Participants:
A total of N=759 adults with MS were enrolled (DirectCAM, n=382; TeleCAM, n=377). Eligible participants were aged 18-70 years, had a self-reported diagnosis of MS, had a Patient-Determined Disease Steps score between 0 and 7, could use their arms or legs for exercise, and had physician clearance.
Interventions:
Participants received the same 12-week CAM exercise program delivered either on-site by a therapist (DirectCAM) or at home using preloaded exercise videos (TeleCAM).
Main Outcome Measures:
Patient-reported outcomes included the Modified Fatigue Impact Scale, the 36-Item Short-Form Health Survey (SF-36) Pain domain, SF-36 Physical and Mental Component scores, and the Godin Leisure-Time Exercise Questionnaire. Performance-based outcomes included the Berg Balance Scale (BBS), the Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go test, the Timed 25-Foot Walk (T25-FW), the 6-minute walk test (6MWT), and grip strength. Outcomes were assessed at baseline and at 3, 6, and 12 months.
Results:
Of the 759 participants across 43 clinics, 382 were assigned to DirectCAM and 377 to TeleCAM. No statistically significant between-group differences were observed in patient-reported outcomes at 3, 6, or 12 months. For performance-based outcomes, improvement on the BBS from baseline to 12 months was greater in DirectCAM than in TeleCAM (2.1; 95% confidence interval, 1.4-2.9; adjusted P<.001). No statistically significant between-group differences were observed in changes in 6MWT, FTSST, or T25-FW.
Conclusions:
DirectCAM and TeleCAM produced comparable improvements in patient-reported outcomes. DirectCAM was superior only on the BBS. Therefore, the hypothesis that TeleCAM would be superior to DirectCAM was not supported.
